In my medical practice, I’ve often had patients ask for a test or procedure, saying, “It’s not costing me – my insurance is paying for it!”

But it is costing you. Even with health insurance, you’re probably aware that your out-of-pocket medical expenses have risen. You’re paying higher deductibles and co-pays, as well as spending more on prescription drugs and insurance premiums.

In fact, the average U.S. worker spent about $400 on out-of-pocket medical expenses in 2011, according to a study by the accounting firm PricewaterhouseCoopers.

Health care is perhaps the only area in which consumers never consider costs. And that’s a sad fact, because they’re increasingly responsible for a greater percentage of those expenditures.

So what can you do to make certain you get the highest-quality health care without going broke? Here are some ways I have found over my years as a physician.

1. Buy the right insurance policy. To get a policy that meets your needs and budget, you’ll need to understand the differences between various insurance plans, such as Preferred Provider (PPO), Health Maintenance Organizations (HMO), Health Savings Accounts (HSA) and Indemnity Insurance.

For example, an HMO has limited options for out-of-network care, but you’ll spend less in out-of-pocket expenses, and have lower co-pays and deductibles than with a PPO. In addition, with an HMO you won’t have to pay co-insurance when seeing your network’s physicians.

Lifescript and other sites have articles to help you understand not only the products, but also the terms used, such as premium, copayment, deductible, coinsurance, maximum out-of-pocket expenses, and lifetime coverage.

2. Look for subsidized clinics. If you can’t afford insurance, check if you or your children might qualify for state-supported assistance. If not, then look into Federally Qualified Health Centers in your area. At these government-funded centers, you pay what you can afford. They provide checkups when you’re well, treatment when you’re sick, pregnancy care, immunizations and checkups for children, dental care, prescription drugs, and mental health and substance abuse care. Many communities also have free clinics; find out if there’s one in your area.

3. Take care of yourself and your family. Cutting medical costs starts with doing all you can to stay healthy.

Develop a regular exercise program, which might be a simple as a daily walk.

Don’t smoke, drink only in moderation, and refrain from illicit drugs.

Make sure your immunizations are up to date; have routine preventive care and age- and gender-appropriate medical tests.

Don’t rush to the doctor at the first sign of a cold, or a mild ankle sprain – use common sense. When in doubt, call your physician or use the toll-free number of your insurance company’s help line to speak directly with their clinician. But see a physician immediately if you have an issue that could be serious, including chest pain with exercise, slurred speech, unexplained rectal bleeding.

If your insurance program or workplace offers wellness programs, see if they might benefit you.

4. Ask for generic drugs. Tell your doctor and pharmacist that you want to take generic medications if available, because they’re cheaper than brand-name drugs. Generics are regulated by the U.S. Food and Drug Administration (FDA) and have the same dose, strength, safety, route of administration and side effects. These drugs are cheaper because the generic manufacturers didn’t have to invest in the cost of developing, testing and marketing the medication. They become available when the original patent expires.

5. Consider using a personal health record for yourself and your family. These allow you to better manage your health issues, leading to more cost-efficient care.

One free online service is Healthvault, which allows you to keep up-to-date records including a detailed history of medications, immunizations, laboratory and x-ray results. By having this information available, you can avoid duplicating tests.

Also, many hospitals and health systems have their own electronic medical records, with a patient portal that allows you to receive and store pertinent information.

6. Fill prescriptions every three months. If your insurance plan allows it, this may be cheaper than buying them monthly.

7. Join a local or online support group. If you have a chronic illness such as diabetes, hypertension, heart failure or chronic lung disease, support groups or websites – such as Patients Like Me – offer a place to take charge of your illness and get educated.

8. Don’t ask for unnecessary tests. In April 2012, nine prestigious medical societies, including the American Academy of Family Physicians, listed 45 common tests and procedures that may often be unnecessary – for example, routine EKGs for patients at low risk for heart disease, or x-rays or scans for uncomplicated headaches or early evaluation of low-back pain. High-tech medicine like MRIs, CT scans, and many other non-invasive tests are expensive and should be done only when clinically appropriate.

If a doctor orders a test and tells you he or she is doing it “just to be certain” or because you’re demanding it, consider postponing the test for a short period to see if the symptoms go away (with the doctor’s assent, of course).

If you go ahead with the test, go to a network provider and, if you have several choices, compare prices. Take the same approach when you’re referred to a new physician. Patients and physicians should always discuss risk, benefits and costs of potential treatments.

9. Avoid the emergency room. Don’t go to a hospital emergency room (ER) for an illness that can be handled in a physician’s office or because you can’t afford a doctor’s visit. ERs are the most expensive place to receive routine care, and you’ll get a hospital bill whether or not you have health insurance. In fact, some emergency rooms now ask for payment at the time of visit for non-emergency care.

Only 16% of ER visits are emergencies, while 60% are urgent or semi-urgent and could probably handled in a different setting. such as an urgent care clinic or primary care office. Interestingly, most non-urgent visits are by patients with insurance, but co-pays are usually quite expensive.

10. Check all your medical bills for errors. About 30% to 40% of bills contain errors, says Stephen T. Parente, Ph.D., a professor of health finance and director of the Medical Industry Leadership Institute at the University of Minnesota. Medical billing errors mar the credit reports of almost 14 million Americans, according to the Commonwealth Fund, a health policy foundation based in New York City and Washington, D.C.

Mistakes can be simply clerical and related to coding for the medical service or treatment, but occasionally you might even be billed for a service you didn’t receive. Also, check that the hospital has your correct address and insurance information, so your bills will be paid on time.

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